Dying on a Wait List?

Perhaps the most emotional of the health care ads we’ve seen in recent months is the one featuring Canadian Shona Holmes, who warns of the dangers of a government-run health care system. Holmes tells viewers: "I survived a brain tumor. But if I’d relied on my government, I’d be dead. … As my brain tumor got worse, my government health care system told me I had to wait six months to see a specialist. In six months, I would have died.”

We wrote about that ad last month, addressing the false claim in the spot that “Washington wants to bring Canadian-style health care to the U.S.” We mentioned that Holmes had told her personal story many times, including in testimony to Congress. She paid for surgery at the Mayo Clinic in Arizona rather than wait several months to see specialists in Canada. But would Holmes’ condition have killed her had she not traveled to the U.S.?

CBC News (the Canadian Broadcasting Corporation) aired a story July 31 quoting a top neurosurgeon in Canada saying that the claim that she would have died is “an exaggeration.” Holmes was diagnosed with Rathke’s cleft cyst, a rare, benign cyst that forms near the pituitary gland. It’s not known to be fatal. Another neurosurgeon told CBC News that he’d never heard of someone dying from the condition.

CBC News, July 31: But the director of the brain tumour research centre at the Montreal Neurological Institute says he thinks that claim is ‘an exaggeration.’

Dr. Rolando Del Maestro says the lesion Holmes was diagnosed with is benign, and usually slow-growing. It typically does not require urgent attention, he said.

‘If it’s a real emergency in the sense that the patient’s visual function is getting substantially worse, the patients would be brought in immediately and would be operated on the next day,’ he said.

In 2005, Holmes, complaining of headaches and vision loss, went to see a Canadian doctor and was put on a six-month waiting list to see specialist.

After trying unsuccessfully to expedite the process, she was diagnosed and treated at the Mayo Clinic. Holmes said U.S. doctors considered the cyst a tumour, and that it would cause death if not removed immediately.

But neurosurgeon Michael Schwartz of Toronto’s Sunnybrook Hospital says he’s never seen or heard of a death from a Rathke’s cyst. He told CBC News symptoms can be alleviated if the cyst is drained or part of it removed to take pressure off the optic nerve. "Then the person’s vision almost always improves."

The Mayo Clinic in Scottsdale, Ariz., where Holmes was treated, wrote about her success story in May 2007. It said that Holmes was in danger of losing her sight, which had been worsening. It didn’t say anything about her being in danger of dying or only having months to live. The neurosurgeon that diagnosed Holmes, Dr. Naresh Patel, said, "We needed to remove the cyst to save her vision." Mayo reported: "When she first saw Dr. Patel, Holmes had lost half the vision in her right eye and 25 percent in her left eye. After the surgery, her vision was 100 percent restored."

We asked the Mayo Clinic about the usual prognosis of the condition. Fredric Meyer, M.D., chair of neurosurgery at Mayo Clinic in Rochester, Minn., responded in a statement that "RCC is a benign lesion and is not typically life-threatening."

Holmes has maintained that her life was in danger. In testimony before the House Energy and Commerce Committee in June, she indicated that she would, or at least could, have died had she waited for treatment in Canada: “If I had relied on my own government-run health care system in Canada, I would not be sitting here before you today. At the very best, I would be blind and the very worst I would be dead,” she told the committee.

According to Canadian news reports, Holmes has faced a barrage of criticism and even “death threats,” she says, for speaking against the Canadian health system in U.S. appearances. Canada’s Globe and Mail newspaper reported July 30 that “she’s increased security at her home and even given the family dog to her daughter, because of threats that her lawn will be poisoned.” The paper reported that Holmes said that Rathke’s cleft cyst was “still considered a tumour, which her American doctors told her would certainly cause death if not removed immediately.“

Dr. Jason Huse, a pathologist at the Sloan-Kettering Cancer Center, told us something different. "By strict definitions it’s not even a tumor," he said, but a remnant of embryological structures that eventually develop into the pituitary gland. Huse stressed that without having examined Holmes, he couldn’t know the prognosis of her RCC: "It is not out of the realm of possibility," he told us, "that this could have been impeding her hormone secretions to the extent that it was a life-threatening situation." And of course, we don’t know what Holmes’ American doctors told her. However, Huse said, RCC "is not typically a malignant lesion and it is not typically life-threatening."

We called and e-mailed the communications director for Americans for Prosperity Foundation, the group behind the ad, asking about Holmes’ statement that she would have died. We have not received a response. The CBC reported that a publicist paid for by the group said Holmes was declining interview requests.

Update, Aug. 9: Shona Holmes released a statement to FactCheck.org through Americans for Prosperity. She says that her husband “was told in no uncertain terms that if I waited the time scheduled to see specialists back in Canada I would be dead.” Holmes is suing the Canadian government and can’t release her medical files, she says. The Mayo Clinic also found that she had Cushing’s disease, a rare endocrine disorder, according to her statement. “My case was so complex – the tumor was not only compromising my optic chiasm but was also damaging my pituitary gland, and it was uncertain whether I had a pituitary tumor on the gland itself,” she says. “I was not producing ACTH, which is fatal, and I had gone into adrenal crisis on 4 different occasions.” She had surgery to treat the adrenal issues in Canada, but she says it took three years to get that operation. “It has just been one nightmare after another,” Holmes says.

“All experts who have reviewed my case, both before and after, made it very clear that I needed surgery within hours to days,” she says. “I wish I could release my medical files, but unfortunately I am in litigation trying to recoup my financial loss from the government.”